Preoperative Lymph Node Staging Research Articles

Radiomics and deep learning models for CT pre-operative lymph node staging in pancreatic ductal adenocarcinoma: A systematic review and meta-analysis

PurposeTo evaluate the diagnostic accuracy of computed tomography (CT)-based radiomic algorithms and deep learning models to preoperatively identify lymph node metastasis (LNM) in patients with pancreatic ductal adenocarcinoma (PDAC). MethodsPubMed, CENTRAL, Scopus, Web of Science and IEEE databases were searched to identify relevant studies published up until February 11, 2024. Two reviewers screened all papers independently for eligibility. Studies reporting the accuracy of CT-based radiomics or deep learning models for detecting LNM in PDAC, using histopathology as the reference standard, were included. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2, the Radiomics Quality Score (RQS) and the the METhodological RadiomICs Score (METRICS). Overall sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR), and the area under the curve (AUC) were calculated. ResultsFour radiomics studies comprising 213 patients and four deep learning studies with 272 patients were included.The average RQS total score was 12.00 ± 3.89, corresponding to an RQS percentage of 33.33 ± 10.80, while the average METRICS score was 63.60 ± 10.88.A significant and strong positive correlation was found between RQS and METRICS (p = 0.016; r = 0.810).The pooled SE, SP, DOR, and AUC of all the studies were 0.83 (95 %CI = 0.77–0.88), 0.76 (95 %CI = 0.62–0.86), 15.70 (95 %CI = 8.12–27.50) and 0.85 (95 %CI = 0.77–0.88).Meta-regression analysis results indicated that neither the study type (radiomics vs deep learning) nor the dataset size of the studies had a significant effect on the DOR (p = 0.09 and p = 0.26, respectively). ConclusionBased on our meta-analysis findings, preoperative CT-based radiomics algorithms and deep learning models demonstrate favorable performance in predicting LNM in patients with PDAC, with a strong correlation between RQS and METRICS of the included studies.

Minimally Invasive with Maximal Yield: A Narrative Review of Current Practices in Mediastinal Lymph Node Staging in Non-Small Cell Lung Cancer.

Background: Lung cancer remains the leading cause of cancer deaths in the United States despite declining incidence and improved outcomes because of advancements in early detection and development of novel therapies. Accurate mediastinal lymph node staging is crucial for determining prognosis and guiding treatment decisions, particularly for non-small cell lung cancer (NSCLC). Materials and Methods: A systematic search of PubMed was conducted to identify English language articles published between January 2010 and January 2024 focusing on preoperative lymph node staging in adults with NSCLC. Case series, observational studies, randomized trials, guidelines, narrative reviews, systematic reviews, and meta-analyses were included. Results: Various imaging modalities, surgical and nonsurgical procedures for mediastinal lymph node staging were reviewed, including positron emission tomography with computed tomography, cervical mediastinoscopy, video-assisted cervical mediastinoscopy, anterior mediastinotomy, video-assisted thoracoscopy, endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA), transesophageal endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), and computed tomography-guided percutaneous lymph node biopsy. EBUS-FNA emerged as the preferred initial staging procedure because of its high sensitivity and low complication rate. Combining it with other procedures or confirmatory testing may be helpful in determining appropriate treatment. Conclusions: Although cervical mediastinoscopy remains a valuable confirmatory procedure in select cases, its role as a first-line staging modality is diminishing with the widespread adoption of EBUS-FNA and EUS-FNA. The combination of EBUS-FNA and EUS-FNA allows access to nearly all mediastinal lymph node stations with high diagnostic accuracy. Future research may further refine the selection criteria for invasive mediastinal staging procedures, ultimately optimizing patient outcomes in the management of NSCLC.

A snapshot on current approaches to lymphadenectomy in liver resection for intrahepatic cholangiocarcinoma: results from an international survey

The use of lymphadenectomy (LND) during resection of intrahepatic cholangiocarcinoma (ICC) is still debated, leading to differing practices in different centers and countries. The aim of this study was to assess such differences. A survey on LND for ICC was distributed to the members of the International Hepato-PancreatoBiliary Association (IHPBA) and the Italian Chapter of IHPBA (AICEP). Two-hundred thirty-four surgeons completed the survey (88% males; median age 46 years). Preoperative nodal staging was deemed mandatory/very important by 65%. Adequate LND was defined as hepatoduodenal ligament LND by 33%, LND at specific nodal stations by 28% and retrieval of > 5 nodes by 28%. The decision to perform LND was influenced by comorbidities (48%), chronic liver disease (38%) and satellitosis (32%). Most participants modify perioperative management in case of clinically positive nodes, 50% stating they would give neoadjuvant therapy. The role of LND in clinically node negative disease was adequate staging for 88%, survival benefit for 50.5% and clinical trials eligibility for 18.5%. Our survey confirms heterogeneity in the evaluation of role and extent of LND for ICC, how this relates to subjective perception of importance of LND, and need of a systematic approach in this area.

Application of radiomics for preoperative prediction of lymph node metastasis in colorectal cancer: A systematic review and Meta-analysis

Background: Colorectal cancer (CRC) stands as the third most prevalent cancer globally, projecting 3.2 million new cases and 1.6 million deaths by 2040. Accurate lymph node metastasis (LNM) detection is critical for determining optimal surgical approaches, including preoperative neoadjuvant chemoradiotherapy and surgery, which significantly influence CRC prognosis. However, conventional imaging lacks adequate precision, prompting exploration into radiomics, which addresses this shortfall by converting medical images into reproducible, quantitative data. Methods: Following PRISMA, Supplemental Digital Content 1, http://links.lww.com/JS9/C77, Supplemental Digital Content 2, http://links.lww.com/JS9/C78 and AMSTAR-2 guidelines, Supplemental Digital Content 3, http://links.lww.com/JS9/C79, we systematically searched PubMed, Web of Science, Embase, Cochrane Library, and Google Scholar databases until January 11, 2024, to evaluate radiomics models’ diagnostic precision in predicting preoperative LNM in CRC patients. The quality and bias risk of the included studies were assessed using the Radiomics Quality Score (RQS) and the modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Subsequently, statistical analyses were conducted. Results: Thirty-six studies encompassing 8,039 patients were included, with a significant concentration in 2022-2023 (20/36). Radiomics models predicting LNM demonstrated a pooled area under the curve (AUC) of 0.814 (95% CI: 0.78-0.85), featuring sensitivity and specificity of 0.77 (95% CI: 0.69, 0.84) and 0.73 (95% CI: 0.67, 0.78), respectively. Subgroup analyses revealed similar AUCs for CT and MRI-based models, and rectal cancer models outperformed colon and colorectal cancers. Additionally, studies utilizing cross-validation, 2D segmentation, internal validation, manual segmentation, prospective design, and single-center populations tended to have higher AUCs. However, these differences were not statistically significant. Radiologists collectively achieved a pooled AUC of 0.659 (95% CI: 0.627, 0.691), significantly differing from the performance of radiomics models (P < 0.001). Conclusion: Artificial intelligence-based radiomics shows promise in preoperative lymph node staging for CRC, exhibiting significant predictive performance. These findings support the integration of radiomics into clinical practice to enhance preoperative strategies in CRC management.

824 Complete Mesocolic Excision Is Safe and Results in Increased Lymph Node Harvest: Further Justification for Randomised Trials

Abstract Aim Complete mesocolic excision (CME) for right hemicolectomy encompasses embryonic dissection planes, radical lymphadenectomy and vascular pedicle ligation at the origin. Compared to conventional D2 dissection, CME is associated with increased disease-free survival in population studies. Critics argue that morbidity from CME may be higher. We sought to examine complication rates and specimen oncologic characteristics in a cohort from a single NHS trust. Method We conducted a retrospective cohort study of all right hemicolectomies performed for adenocarcinoma between 3/1/2019 and 15/11/2022. The choice of CME or D2 lymphadenectomy was at the discretion of the operating surgeon. Data were collected from paper notes and electronic records. Statistical analyses used non-parametric testing. Results CME was performed in 30 patients and D2 resection in 99. The CME group were younger (70 vs. 72 years, p = 0.04) and preoperative nodal staging was higher. There were no differences in duration of surgery, estimated blood loss, postoperative haemoglobin or transfusion requirement. Only 20% patients in the CME group had a significant complication compared to 40% of the D2 group (p = 0.05) and length of stay was reduced (5 vs. 7 days, p = 0.02). Nodal harvest was increased in the CME group (24 vs. 19, p = 0.01) with no difference in R0 resection rate. Conclusions CME appears to be safe and does not result in increased complication rates in this single institution cohort. Nodal harvest is increased with comparable margin clearance. Whether this translates to increased disease-free survival is unclear. There is equipoise and randomised studies examining long-term outcomes are justified.

Additional Value of PET and CT Image-Based Features in the Detection of Occult Lymph Node Metastases in Lung Cancer: A Systematic Review of the Literature.

Lung cancer represents the second most common malignancy worldwide and lymph node (LN) involvement serves as a crucial prognostic factor for tailoring treatment approaches. Invasive methods, such as mediastinoscopy and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), are employed for preoperative LN staging. Among the preoperative non-invasive diagnostic methods, computed tomography (CT) and, recently, positron emission tomography (PET)/CT with fluorine-18-fludeoxyglucose ([18F]FDG) are routinely recommended by several guidelines; however, they can both miss pathologically proven LN metastases, with an incidence up to 26% for patients staged with [18F]FDG PET/CT. These undetected metastases, known as occult LN metastases (OLMs), are usually cases of micro-metastasis or small LN metastasis (shortest radius below 10 mm). Hence, it is crucial to find novel approaches to increase their discovery rate. Radiomics is an emerging field that seeks to uncover and quantify the concealed information present in biomedical images by utilising machine or deep learning approaches. The extracted features can be integrated into predictive models, as numerous reports have emphasised their usefulness in the staging of lung cancer. However, there is a paucity of studies examining the detection of OLMs using quantitative features derived from images. Hence, the objective of this review was to investigate the potential application of PET- and/or CT-derived quantitative radiomic features for the identification of OLMs.

Histology of the Primary Tumor Correlates with False Positivity of Integrated 18F-FDG-PET/CT Lymph Node Staging in Resectable Lung Cancer Patients.

This study aimed to evaluate the diagnostic accuracy and false positivity rate of lymph node (LN) staging assessed by integrated 18F-fluorodeoxyglucose positron emission computed tomography (18F-FDG-PET/CT) in patients with operable lung cancer to the tumor histology. In total, 129 consecutive patients with non-small-cell lung cancer (NSCLC) undergoing anatomical lung resections were included. Preoperative LN staging was evaluated in the relationship to the histology of the resected specimens (group 1: lung adenocarcinoma/LUAD; group 2: squamous cell carcinoma/SQCA). Statistical analysis was performed by the Mann-Whitney U-test, the chi2 test, and binary logistic regression analysis. To establish an easy-to-use algorithm for the identification of LN false positivity, a decision tree including clinically meaningful parameters was generated. In total, 77 (59.7%) and 52 (40.3%) patients were included in the LUAD and SQCA groups, respectively. SQCA histology, non-G1 tumors, and tumor SUVmax > 12.65 were identified as independent predictors of LN false positivity in the preoperative staging. The corresponding ORs and their 95% CIs were 3.35 [1.10-10.22], p = 0.0339; 4.60 [1.06-19.94], p = 0.0412; and 2.76 [1.01-7.55], and p = 0.0483. The preoperative identification of false-positive LNs is an important aspect of the treatment regimen for patients with operable lung cancer; thus, these preliminary findings should be further evaluated in larger patient cohorts.

Comparison of [68Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/MRI in the Preoperative Diagnosis of Gastric Cancer.

Our objective was to compare the value of positron emission tomography/magnetic resonance imaging (PET/MRI) with the new imaging agent [68Ga]Ga-DOTA-FAPI-04 and the traditional imaging agent [18F]FDG for the preoperative diagnosis of gastric cancer. Forty patients with gastric cancer diagnosed by gastroscopy in gastrointestinal surgery at our hospital from June 2020 to January 2021 were analyzed. All patients underwent simultaneous [68Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/MRI. The standard uptake value (SUV), fat removal standard uptake value (SUL), and diagnostic sensitivity, specificity, and accuracy for primary and metastatic lesions were compared, and their diagnostic value for different lymph node dissection stages was analyzed. The median age of the patients in this cohort was 68 years. Twenty-nine patients underwent surgery, and 11 patients underwent gastroscopic biopsy. The SUVmax of primary lesions in the FDG group and the FAPI group was 5.74 ± 5.09 and 8.06 ± 4.88, respectively (P < 0.01); SULmax values were 3.52 ± 2.80 and 5.64 ± 3.25, respectively (P < 0.01). The SUVmax of metastases in the two groups was 3.81 ± 3.08 and 5.17 ± 2.80, respectively (P < 0.05). The diagnostic sensitivities for primary lesions in the FDG group and the FAPI group were 0.72 and 0.94, respectively (P < 0.05). Combined with postoperative pathological staging, there was no difference in diagnostic sensitivity and specificity of lymph node staging between the FDG and FAPI groups (P > 0.05). Compared with the traditional imaging agent, [68Ga]Ga-DOTA-FAPI-04 has better diagnostic efficiency but no substantial advantage for preoperative lymph node staging.

Prospective Evaluation of Quantitative F-18-FDG-PET/CT for Pre-Operative Thoracic Lymph Node Staging in Patients with Lung Cancer as a Target for Computer-Aided Diagnosis

Pre-operative assessment of thoracic lymphonodal (LN) involvement in patients with lung cancer (LC) is crucial when choosing the treatment modality. Visual assessment of F-18-FDG-PET/CT (PET/CT) is well established, however, there is still a need for prospective quantitative data to differentiate benign from malignant lesions which would simplify staging and guide the further implementation of computer-aided diagnosis (CAD). In this prospective study, 37 patients with confirmed lung cancer (m/f = 24/13; age: 70 [52-83] years) were analyzed. All patients underwent PET/CT and quantitative data (standardized uptake values) were obtained. Histological results were available for 101 thoracic lymph nodes. Quantitative data were matched to determine cut-off values for delineation between benign vs. malignant lymph nodes. Furthermore, a scoring system derived from these cut-off values was established. Statistical analyses were performed through ROC analysis. Quantitative analysis revealed the optimal cut-off values (p < 0.01) for the differentiation between benign and malignant thoracic lymph nodes in patients suffering from lung cancer. The respective areas under the curve (AUC) ranged from 0.86 to 0.94. The highest AUC for a ratio of lymph node to healthy lung tissue was 0.94. The resulting accuracy ranged from 78.2% to 89.1%. A dedicated scoring system led to an AUC of 0.93 with a negative predictive value of 95.4%. Quantitative analysis of F-18-FDG-PET/CT data provides reliable results for delineation between benign and malignant thoracic lymph nodes. Thus, quantitative parameters can improve diagnostic accuracy and reliability and can also facilitate the handling of the steadily increasing number of clinical examinations.

Abstract P5-01-02: Diagnostic Accuracy of 18F-FDG PET/CT plus Contrast-Enhanced MRI for Axillary Lymph Node Metastasis Involved in Invasive Ductal Carcinoma

Abstract Background: Positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) are useful imaging modalities for the preoperative nodal staging in breast cancer; however, clinical evidence demonstrating the diagnostic accuracy of the combination of PET/CT and MRI is limited. The purpose of this study is to establish a clinical prediction model based on PET/CT plus contrast-enhanced MRI for ALN metastasis, and explore the possibility of non-invasive patients’ risk stratification using the PET/CT plus MRI model preoperatively. Methods: A total of 361 women (370 axillae; mean age, 56 years ± 12 [standard deviation]) who underwent surgery for primary invasive ductal carcinoma at a single institution between April 2017 and March 2020 were evaluated. Subjects were divided into two cohorts: a derivation cohort (n = 333) and a validation cohort (n = 37). In the derivation cohort, we constructed a prediction model with logistic regression to estimate the potential explanatory variables obtained by PET/CT, MRI, and preoperative core-needle biopsy. Using a simple integer risk score, patients were divided into low-risk and high-risk groups. We assessed the predictive ability of the PET/CT plus MRI model using the area under the curve (AUC), and internal validation was achieved by risk scoring system in the validation cohort. Results: The PET/CT plus MRI model included five predictor variables: maximum standardized uptake value of primary tumor and ALN, primary tumor size, ALN cortical thickness, and histological grade. The PET/CT plus MRI model had significantly improved AUC of 0.867 (p &amp;lt; 0.05) as compared to those of the PET/CT model (AUC = 0.821) and MRI model (AUC = 0.815). We assigned the weighted scores to each retained variables in the PET/CT plus MRI model, and determined the optimal cut-off value of 7 (range, 0−17). In the derivation and validation cohorts, 55% and 65% of the patients were classified as low-risk by the risk scoring system, with negative predictive values of 97% and 100%, respectively. Conclusions: Our findings demonstrated a better diagnostic accuracy of the clinical prediction model utilizing both PET/CT and MRI than previous models based on either PET/CT or MRI, and the negative predictive value of 97% was not inferior to that of sentinel lymph node biopsy. Thus, the preoperative risk evaluation of axillary lymph node macrometastasis using our integrated model could be useful while considering individualized therapy for patients with invasive ductal breast cancer. Further validation should be performed for clinical applications. Citation Format: Shun Kawaguchi, Nobuko Tamura, Kiyo Tanaka, Yoko Kobayashi, Junichiro Sato, Keiichi Kinowaki, Masato Shiiba, Makiko Ishihara, Hidetaka Kawabata. Diagnostic Accuracy of 18F-FDG PET/CT plus Contrast-Enhanced MRI for Axillary Lymph Node Metastasis Involved in Invasive Ductal Carcinoma [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-01-02.

Usefulness of pyruvate dehydrogenase-E1α expression to determine SUVmax cut-off value of [18F]FDG-PET for predicting lymph node metastasis in lung cancer

A more accurate cut-off value of maximum standardized uptake value (SUVmax) in [18F]fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG-PET/CT) is necessary to improve preoperative nodal staging in patients with lung cancer. Overall, 223 patients with lung cancer who had undergone [18F]FDG-PET/CT within 2 months before surgery were enrolled. The expression of glucose transporter-1, pyruvate kinase-M2, pyruvate dehydrogenase-E1α (PDH-E1α), and carbonic anhydrase-9 was evaluated by immunohistochemistry. Clinicopathological background was retrospectively investigated. According to PDH-E1α expression in primary lesion, a significant difference (p = 0.021) in SUVmax of metastatic lymph nodes (3.0 with PDH-positive vs 4.5 with PDH-negative) was found, but not of other enzymes. When the cut-off value of SUVmax was set to 2.5, the sensitivity and specificity were 0.529 and 0.562, respectively, and the positive and negative predictive values were 0.505 and 0.586, respectively. However, when the cut-off value of SUVmax was set according to PDH-E1α expression (2.7 with PDH-positive and 3.2 with PDH-negative), the sensitivity and specificity were 0.441 and 0.868, respectively, and the positive and negative predictive values were 0.738 and 0.648, respectively. The SUVmax cut-off value for metastatic lymph nodes depends on PDH-E1α expression in primary lung cancer. The new SUVmax cut-off value according to PDH-E1α expression showed higher specificity for [18F]FDG-PET in the diagnosis of lymph node metastasis.

The implementation of a noninvasive lymph node staging (NILS) preoperative prediction model is cost effective in primary breast cancer

PurposeThe need for sentinel lymph node biopsy (SLNB) in clinically node-negative (cN0) patients is currently questioned. Our objective was to investigate the cost-effectiveness of a preoperative noninvasive lymph node staging (NILS) model (an artificial neural network model) for predicting pathological nodal status in patients with cN0 breast cancer (BC).MethodsA health-economic decision-analytic model was developed to evaluate the utility of the NILS model in reducing the proportion of cN0 patients with low predicted risk undergoing SLNB. The model used information from a national registry and published studies, and three sensitivity/specificity scenarios of the NILS model were evaluated. Subgroup analysis explored the outcomes of breast-conserving surgery (BCS) or mastectomy. The results are presented as cost (€) and quality-adjusted life years (QALYs) per 1000 patients.ResultsAll three scenarios of the NILS model reduced total costs (–€93,244 to –€398,941 per 1000 patients). The overall health benefit allowing for the impact of SLNB complications was a net health gain (7.0–26.9 QALYs per 1000 patients). Sensitivity analyses disregarding reduced quality of life from lymphedema showed a small loss in total health benefits (0.4–4.0 QALYs per 1000 patients) because of the reduction in total life years (0.6–6.5 life years per 1000 patients) after reduced adjuvant treatment. Subgroup analyses showed greater cost reductions and QALY gains in patients undergoing BCS.ConclusionImplementing the NILS model to identify patients with low risk for nodal metastases was associated with substantial cost reductions and likely overall health gains, especially in patients undergoing BCS.

Diagnostic accuracy of preoperative lymph node staging of bladder cancer according to different lymph node locations: A multicenter cohort from the European Association of Urology - Young Academic Urologists.

The preoperative lymph node (LN) staging of bladder cancer (BCa) addresses the subsequent therapeutic strategy and influences patient's prognosis. However, sparce evidence exists regarding the accuracy of conventional cross-sectional imaging, such as computed tomography or magnetic resonance imaging, in correctly detect LN status. We aimed to assess the diagnostic accuracy of conventional cross-sectional imaging in detecting preoperative LN involvement among BCa patients treated with radical cystectomy and pelvic lymph node dissection. We retrospectively analyzed data of 1,104 patients who underwent preoperative LN staging with computed tomography or magnetic resonance imaging and subsequent radical cystectomy with pelvic lymph node dissection for BCa between 1997 and 2017 at three tertiary referral centers. Patients receiving neoadjuvant chemotherapy were excluded. We assessed the concordance between clinical (cN) and pathological LN (pN) status, defined as the accuracy of imaging in detecting LN involvement using pathological specimen as reference; concordance was expressed according to Cohen's kappa coefficient. Location-based sub-analyses were performed, distinguishing among external iliac, intern iliac, obturator, common iliac, presacral and paraaortic LNs. Among 870 cN0 patients, 68.9% were confirmed pN0 at pathological report; while among 234 cN+ patients, 50.5% were found with LN metastases at pathological specimen. Overall, conventional imaging showed slight concordance (64.9%) between cN and pN stages (sensitivity: 30%; specificity: 84%). At sub-analysis, no agreement between cN and pN status was found in each LN location, with the only exception of common iliac LNs with slight concordance (37.5%). Common iliac LNs achieved the highest sensitivity and positive likelihood ratio (15% and 2.4, respectively) compared to other LN locations. Overall, preoperative cross-sectional imaging exhibited a slight concordance between cN and pN status. Our location-based sub-analyses showed unsatisfactory results in each LN location- Thus, nomograms combining morphological patterns with serological and clinicopathological features are urgently required.

Optimization of Preoperative Lymph Node Staging in Patients with Muscle-Invasive Bladder Cancer Using Radiomics on Computed Tomography.

Approximately 25% of the patients with muscle-invasive bladder cancer (MIBC) who are clinically node negative have occult lymph node metastases at radical cystectomy (RC) and pelvic lymph node dissection. The aim of this study was to evaluate preoperative CT-based radiomics to differentiate between pN+ and pN0 disease in patients with clinical stage cT2-T4aN0-N1M0 MIBC. Patients with cT2-T4aN0-N1M0 MIBC, of whom preoperative CT scans and pathology reports were available, were included from the prospective, multicenter CirGuidance trial. After manual segmentation of the lymph nodes, 564 radiomics features were extracted. A combination of different machine-learning methods was used to develop various decision models to differentiate between patients with pN+ and pN0 disease. A total of 209 patients (159 pN0; 50 pN+) were included, with a total of 3153 segmented lymph nodes. None of the individual radiomics features showed significant differences between pN+ and pN0 disease, and none of the radiomics models performed substantially better than random guessing. Hence, CT-based radiomics does not contribute to differentiation between pN+ and pN0 disease in patients with cT2-T4aN0-N1M0 MIBC.

Clinicopathological and ultrasound features as risk stratification predictors of clinical and pathological nodal status in papillary thyroid carcinoma: a study of 748 patients

BackgroundPapillary thyroid carcinoma (PTC) is the most common histological type of thyroid malignancy that tends to metastasize to cervical lymph nodes. In the present study, we aimed to investigate which clinicopathologic and ultrasound features of PTC are associated with clinical lymph node metastasis (LNM) and numbers of pathological LNM.MethodsFrom January 2016 to December 2018, we identified a cohort of patients with PTC who underwent cervical ultrasonography and were diagnosed through operation and pathology. Clinical N1(cN1) and > 5 pathologic N1(pN1) were considered in the postoperative stratification to have an intermediate risk according to the 2015 ATA guidelines. Clinicopathological and ultrasound features in PTC patients were performed in accordance with the independent risk factors of cN1 and > 5pN1 respectively by using the univariate and multivariate analyses.ResultsWe collected 748 PTC patients in the final inclusion criteria. There were 688 cN0 cases and 60 cN1 cases. From the analyses, primary tumor size > 2 cm, capsule contact, extrathyroidal extensions (ETE) and central LNM remained independent risk factors for cN1 in PTC patients. In the 748 PTC patients, 707 cases had ≤ 5 pN1, and 41 cases had > 5 pN1. Multifocality, primary tumor size > 2 cm, capsule contact and ETE are significant independent risk factors for > 5 pN1. ConclusionsWe concluded that multifocality, primary tumor size > 2 cm, capsule contact, ETE and central LNM were independent risk factors for the intermediate risk stratification in patients with PTC. Ultrasonography is a good technique for the preoperative lymph node staging of PTC and is helpful for detecting LNM.

Abstract P1-01-11: Axillary extensive burden evaluation by ultrasound in preoperative nodal staging in breast cancer patients

Abstract Purpose :Since ACOSOG Z1011 trial, the role of axillary US preoperative has been redirected for predicting extensive axillary involvement. Our study is aimed to evaluate routinely US axillary prediction for extensive nodal burden in breast cancer. Materials and methods :The study was approved by the institutional reaview board and the requirement for in-formed consent was waived.All patients in our institution with early-stage invasive breast cancer have a systematic axillary ultrasound (US) evaluation before surgery.A prospective study of radiology and pathology records concerns all consecutives patients to evaluate US correlation with surgical findings beetwen November 1, 2020 and July 15, 2021.Neoadjuvant chemotherapy, ductal carcinoma in situ on breast biopsy, and relapse cases were excluded.Criteria used to define abnormal lymph nodes included : focal or diffuse cortical thickening with cortex thicker than &amp;gt;4mm, replacement or effacement of the fatty hilium, or rounder lymph node.3 US prediction groups were defined as: US G0 normal (no suspicious lymph node) ;US G1 non extensive involvement (1 or 2 suspicious nodes) ; US G2 extensive involvement (≥3 suspicious nodes).In case of preoperative positive axillary biopsy, positive intraoperative examination, or patients without Acosog criteria, an axillary dissection was systematically performed.3 pathologic groups were defined as : path G0 (pN0) ; path G1 (≤2pN+) ; path G2 (≥3pN+).Statiscal analysis was performed with the chi-square the Fisher’s exact test.NPV for extensive axillary burden is defined as the proportion of patients with a negative test result (US G0 or US G1) that does not have extensive nodal involvement histologically (path G0 or path G1). Results. The study is still ongoing. On the 241 first cases, 64.3% (155/241) were cT1, 82.9% (200/241) were cN0. 163(78.3%) had Ductal invasive carcinoma, 37 were lobular histologic characteristics (17.8%) and 8 were mixted (3.8%).6.2% (15/241) patients presented extensive nodal involvement. ConclusionThe results of this study are preliminary. They will be completed after the next study closure. In the first results, it is globally observed that the preoperative ultrasound makes it possible to exclude more than 97% of extensive involvement (&amp;gt;2pN+). In case of less than 3 US suspected axillary nodes , sentinel node biospy remains indicated. The false negative rate cannot be calculated on this day and will not be presented until later. Path G0Path G1Path G2totalUS G0156243187US G1310922US G20033total1593415241VPN for extensive nodal disease is 97.9% (193/197).In abnormal US groups (US G1+US G2), 48% (12/24) patients had extensive axillary involvement. Citation Format: Camille Defoort, Joanna Chemaly, Luc Ceugnart, Marie-Pierre Chauvet. Axillary extensive burden evaluation by ultrasound in preoperative nodal staging in breast cancer patients [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-01-11.

A0758 - Diagnostic accuracy of preoperative lymph node staging of bladder cancer according to different lymph node locations: A multicenter cohort from the European Association of Urology – Young Academic Urologists

A0758 - Diagnostic accuracy of preoperative lymph node staging of bladder cancer according to different lymph node locations: A multicenter cohort from the European Association of Urology – Young Academic Urologists

Sonographic Diagnosis of Cervical Lymph Node Metastasis in Patients with Thyroid Cancer and Comparison of European and Korean Guidelines for Stratifying the Risk of Malignant Lymph Node.

To evaluate the ultrasonography (US) features for diagnosing metastasis in cervical lymph nodes (LNs) in patients with thyroid cancer and compare the US classification of risk of LN metastasis between European and Korean guidelines. From January 2014 to December 2018, US-guided fine-needle aspiration was performed on 836 LNs from 714 patients for the preoperative nodal staging of thyroid cancer. The US features of LNs were retrospectively reviewed for the following features: size, presence of hilum, margin, orientation, cystic change, punctate echogenic foci (PEF), large echogenic foci, eccentric cortical thickening, abnormal vascularity, and cortical hyperechogenicity. A multiple logistic regression analysis was performed to identify the independent US features for the diagnosis of metastatic LNs. The diagnostic performance of independent US features was subsequently evaluated. LNs were categorized according to the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and European Thyroid Association (ETA) guidelines, and the correlation between the two sets of classifications was assessed. Absence of the hilum, presence of cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity were independent US features of metastatic LNs. Cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity showed high specificity (86.8%-99.6%). The absence of the hilum had the highest sensitivity yet low specificity (66.4%). When LNs were classified according to the ETA guidelines and K-TIRADS, they yielded similar categorizations of malignancy risks and were strongly correlated (Spearman coefficient, 0.9766 [95% confidence interval, 0.973-0.979]). According to the ETA guidelines, 9.8% (82/836) of LNs were classified as "not specified." Absence of hilum, cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity were independent US features suggestive of metastatic LNs in thyroid cancer. Both K-TIRADS and the ETA guidelines provided similar risk stratification for metastatic LNs with a high correlation; however, the ETA guidelines failed to classify 9.8% of LNs into a specific risk stratum. These results may provide a basis for revising LN classification in future guidelines.

Definitions of Central Tumors in Radiologically Node-Negative, Early-Stage Lung Cancer for Preoperative Mediastinal Lymph Node Staging: A Dual-Institution, Multireader Study

Definitions for central lung cancer (CLC) have been ambiguous in guidelines, causing difficulty in selecting candidates for invasive mediastinal staging among patients with radiologically node-negative, early-stage lung cancer. What is the optimal definition for CLC that is robust to interreader and institutional variation to select candidates for invasive mediastinal staging among those with clinical T1N0M0 lung cancer? Two retrospective cohorts were evaluated for the associations of central lung cancer according to 13 definitions based on chest CT scan with occult nodal metastasis. Univariate and multivariate ordinal logistic regression analyses were performed with the pathologic N category as an ordinal outcome. Robust definitions, which retained statistical significance across multireader, dual-institutional datasets, were identified. For these definitions, binary diagnostic performance and interreader agreement were investigated. In the two cohorts, 807 patients (median age, 63 years; interquartile range [IQR], 56-71 years; 410 women; 33 pN1, 48 pN2, and 1 pN3) and 510 patients (median age, 65 years; IQR, 58-71 years; 267 women; 33 pN1, 20 pN2, and no pN3) were included, respectively. Three definitions robust to interreader variation and dataset heterogeneity were identified: definition 7 (concentric lines arising from the midline, inner one-third, medial margin; adjusted OR, 2.01; 95%CI, 1.13-3.51; P= .02), definition 10 (location index-based inner one-third, center; adjusted OR, 3.60; 95%CI, 1.49-8.25; P= .003), and definition 12 (location index-based inner one-third, medial margin; adjusted OR, 3.57; 95%CI, 1.91-6.52; P< .001). Definition 12 showed higher interreader agreement than definition 7 (Cohen κ, 0.80 vs0.66; P= .005). Nevertheless, the sensitivity and positive predictive value of the three definitions were< 50%. Three definitions exhibited robust associations with occult nodal metastasis. However, selecting candidates for invasive mediastinal staging solely based on a central tumor location would be suboptimal.

SC251 - Diagnostic accuracy of preoperative lymph node staging of bladder cancer according to different lymph node locations: a multicentre cohort from the european association of urology – young academic urologists (EAU-YAU): urothelial carcinoma working group

SC251 - Diagnostic accuracy of preoperative lymph node staging of bladder cancer according to different lymph node locations: a multicentre cohort from the european association of urology – young academic urologists (EAU-YAU): urothelial carcinoma working group